HomeMy WebLinkAboutBLDE-24-256 2/2_ .,'.:.!AM about:blank
Commonwealth of Massachusetts
* Town of Yarmouth ,,, c
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ELECTRICAL PERMIT
Job Address: 49 GROUSE LN Unit:
Owner Name: BAUTZ BERNARD C TR
Owner's Address: 49 GROUSE LN Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? Yes Permit Number: BLDE-24-256
Existing Service Amps/Volts Overhead❑ Underground ❑ No. of Meters:
New Service Amps/Volts Overhead❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Convert garage to bedroom.
No.of Receptacle Outlets: 10 No.of Switches: 4 Generator KW Rating: Type:
No.Luminaires: 6 No.of Recessed Luminaires: 4 No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
No. Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of Devices:
Swimming Pool: ln-Grnd.❑ Above-Grnd.❑ Hot Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No. Gas Burners: Video System ❑ No.of Devices:
No.Air Conditioners: Total Tons: Telecom System ❑ No.of Outlets:
No. Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount❑ Ground-Mount❑ Level 1 ❑ Level 2❑ Level 3❑ Rating:
Estimated Value of Electrical Work: $600 Work to Start: February 15, 2024
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: ROBERT J CARLSON License Number: 16945
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: W YARMOUTH, MA, 026733752 W YARMOUTH MA 026733752 Fee Paid: $75.00
Email: bobcarlsonelectric@gmail.com Business Telephone: 508-294-2416
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the
licensee provides proof of liability insurance including "completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
INSURANCE:
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_', Official Use Only
t • 2024 t ommonwealth of Massachusetts y
t • Permit No.: CC -t—ZS co
w ' Department of Fire Services Occupancy and Fee Checked:
`i Alt11 OF FIRE PREVENTION REGULATIONS [Rev.I/2023)
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
City or Town of: YARMOUTH • Date: -/G 2y
To the Inspector of Wires:By this,�/application,the undersigned gives noti of.his or her intention to perform the electrical work described below.
Location(Street&Number): / 9 6 Unit No.:
Owner or Tenant: Vo.'.. w'L- ✓S,q '7-Z Email:
Owner's Address: 4/9 G/ro 4/fiver Phone No.: 6t'019f/24'/Z.
Is this permit in conjunction with a building permit?(Check appropriate box)Yes®'No 0 Permit No.:{S/IR V-3'y
Purpose of Building: Utility Authorization No.:
Existing Service: /ea Amps /li/t y0 Volts Overhead 13- Underground❑ No.of Meters: /
New Service: Amps / Volts/ Overhead El Underground❑ No.of Meters:
, Description of Proposed Electrical Installation: C//6(') (c/44/1 t- ,'!UTZS 4ee'-
Completion of the following table may be waived by the Inspector of Wires.
No.of Acceptable Outlets: /p No.of Switches: Generator KW Rating: Type:
No.Luminaires: 6, No.of Recessed Luminaires: '/ No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of Devices:
Swimming Pool:In-Grnd.❑ Above-Gmd.❑ Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices:
No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System❑ No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount❑ Ground-Mount❑ Level 1❑ Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wirer.
Estimated Value of Electra Wo : Cela /oo (When required by municipal policy)
Date Work to Start: I I'S 4/ Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: C/11 /f oA eF/6 ' -'i A-I 0 or C-1 0 LIC.No.:
Master/Systems Licensee: GedQS#�*J CJ t I ?tkDi""*" LIC.No.: /6 VS--
Journeyman Licensee: a7OGs/>/1T rT C/f4//,r ' LIC.No.: e 3 eg 6 ?
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: 35' /Vie fi/"4:0 n/ C ,W%I rG/Z
Email: ea6 6-7.q/i/CON /Ce T/rj�'( 6/ivrAL/eatoTelephoneNo.: reef- A9//S9'
I cell under the pains and penalties of perjury,that the information on this application is true and complete. s�/�
Licensee:/?e b¢"Oi/CyrA's/A/PrintName:?ry IGi✓6Gr� /y//� Cell.No.:�6 t9L/v/(C
INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof of same to the permit issuing office. a
CHECK ONE: INSURANCE gr BOND❑ OTHER El Specify: 2-6,4"•e
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the liability insurance coverage normally
required by law.By my signature below,I hereby waive this requirement.I am the:(Check one)Owner❑ Owner's agent 0
Owner/Agent: Tel.No.:
Signature: Email.: 4r7!5
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